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Scapholunate Ligament Injury

SL interosseous ligament injury: instability spectrum to SLAC, scaphoid-shift and imaging, arthroscopic grading, and repair/capsulodesis/tenodesis by chronicity.

123 citationsUpdated Sep 2026

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Overview

Scapholunate ligament injury is a critical cause of carpal instability, where early arthroscopic diagnosis is mandatory to establish prognosis [7]. Arthroscopy remains the gold standard for complete evaluation and is often performed as a first step before repair or reconstruction [25]. The incidence of intrinsic and extrinsic ligament injuries in scaphoid waist fractures is higher than previously reported, emphasizing the need for careful assessment of the scapholunate ligament before deciding on treatment [4]. The palmar portion of the ligament plays a stabilizing role and should be considered for surgical repair [168].

No strong evidence currently supports any one treatment for scapholunate ligament injuries [8]. Strong evidence (level 1 or 2) for management of scapholunate instability in the absence of arthritis is lacking, and published recommendations are largely experience-based [66]. Despite the evolution of diagnostic and treatment options, the ideal treatment for scapholunate instability remains an unresolved problem with inconsistent results and ongoing concerns regarding complications [9]. Current opinion supports repairing or reconstructing the scapholunate interosseous ligament in active individuals with instability symptoms and minimal or no carpal arthritis, though no clear consensus exists for all scenarios [10]. A proper ligament repair is recommended within four to six weeks after trauma [7]. Surgical repair with augmentation ligamentoplasty is indicated for disabling scapholunate interosseous ligament disruption before the occurrence of static, fixed scapholunate dissociation [163].

Direct bony fixation of the ruptured scapholunate ligament using a suture anchor is generally successful in restoring stability and has produced acceptable functional mid-term results [22]. Arthroscopic capsulodesis offers significant functional improvement and a low complication rate in higher grade injuries [34]. Both versions of the scapholunate intercarpal ligamentoplasty yield satisfactory clinical and radiological results in the short to mid-term [35]. Scapholunate ligament reconstruction using a part of the extensor carpi radialis brevis tendon through a dorsal approach resulted in long-term, improved outcomes compared with other techniques, even in scapholunate advanced collapse type I wrists [24]. Repair techniques for isolated volar scapholunate interosseous ligament injuries appear promising with the limited data available [63]. Treatment of static scapholunate instability with modified Brunelli tenodesis resulted in a certain loss of scapholunate reduction at final follow-up [19]. An algorithm of treatment based on prognostic factors is presented to help decide which surgical technique is best for each individual case of scapholunate dissociation [18]. Various surgical techniques for scapholunate ligament repair or reconstruction are reviewed based on clinical stages and anatomic-pathologic findings, proposing specific indications for each type of tear from dorsal capsulodesis to tenodesis procedures [57]. The outcomes of intraarticular fractures of the distal radius with operatively treated associated scapholunate ligament injury are comparable with the outcomes of intraarticular fractures of the distal radius without associated scapholunate ligament injury [12]. In carefully selected cases of severe carpal trauma, acute salvage procedures may be a viable alternative to ORIF and ligament repair/reconstruction [36]. Concomitant scaphoid fracture and SL ligament injury may represent a relative contraindication to the use of a scapholunate screw [48]. For stage II SLAC wrist with a preserved capitolunate joint, proximal row carpectomy is preferred because it is technically less demanding and yields durable results [171].

Anatomy & Pathophysiology

Bony Anatomy

The wrist comprises eight carpal bones arranged in two rows: the proximal row (scaphoid, lunate, triquetrum, pisiform) and the distal row (trapezium, trapezoid, capitate, hamate) [77]. The distal radius articular surface features two concave facets for the scaphoid and lunate, separated by a ridge corresponding to the scapholunate interval [82]. In the frontal plane, the distal radius is oriented with an average of 11 degrees of volar tilt and 23 degrees of radial inclination [82]. The lunate is broader palmarly than dorsally [88]. The scaphoid's primary vascular supply is a branch of the radial artery at the dorsal ridge, with smaller vessels entering the palmar tubercle to supply the distal 30% [88]. The capitate head often relies on a retrograde vascular supply [88].

Ligamentous Anatomy

The scapholunate interosseous ligament (SLIL) is C-shaped in the sagittal plane, consisting of dorsal, palmar, and interosseous portions [83]. The dorsal portion of the scapholunate interosseous ligament is the thickest and strongest component [83]. Conversely, the lunotriquetral interosseous ligament is C-shaped, with the volar portion being the thickest and strongest [83]. The dorsal intercarpal ligament passes from the dorsal tubercle of the triquetrum to the distal pole of the scaphoid [83]. This ligament reinforces the elastic dorsal wrist capsule and contributes to stabilizing the scapholunate articulation via deep fibers [83]. The space of Poirier is a weak area adjacent to the proximal capitate without ligamentous attachment, situated ulnar to the radioscaphocapitate ligament and radial to the long radiolunate ligament [83]. During perilunate dislocation, the distal carpal row separates from the lunate through the space of Poirier [83]. The dorsal radiocarpal ligament has a trapezoidal shape, passing from the dorsal rim of the distal radius to the lunate and triquetrum [83]. The radioscapholunate ligament is a vascular conduit rather than a true ligament, also known as the ligament of Testut [83]. The scapholunate interosseous ligament is the most commonly injured wrist ligament and a major stabilizer of the wrist [83]. The dorsal wrist ganglion typically originates from the scapholunate ligament, with the main cyst located directly over it [40]. A mucin-filled duct invariably pierces the transverse fibers of the scapholunate ligament, connecting the underlying scapholunate joint to dorsal ganglion cysts [40].

Kinematics and Biomechanics

The wrist functions as a two-joint system linking the hand to the forearm via the mobile proximal carpal row [89]. The proximal carpal row has no muscular or tendinous attachments and acts as an intercalary segment [88]. Approximately 62% of wrist extension occurs through the radiocarpal joint, while 62% of wrist flexion occurs through the midcarpal joint [83]. The midcarpal joint is primarily responsible for 20 degrees of radial deviation and 40 degrees of ulnar deviation [83]. The radius bears 80% of the axial load transmitted through the radiocarpal joint, while the ulna bears 20% in neutral ulnar variance [83]. During wrist flexion from neutral, the proximal row translates dorsally, and the scaphoid pronates [83]. During wrist extension from neutral, the proximal row translates palmarly, and the scaphoid supinates [83]. The dart-thrower's motion involves moving from radial extension into ulnar flexion and occurs almost exclusively through the midcarpal joint [89]. Clinically, a dart-thrower's motion at approximately 30° to 45° from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion [94]. Most carpal ligaments lengthen only during one half of a full movement cycle, constraining either dorsal/palmar or ulnar/radial directed motion [108]. The wrist behaves kinematically consistent but kinetically variable, implying mechanical behavior is predominantly determined by articular geometry rather than ligament constraints [76]. During simple unresisted wrist motions, the force in the scapholunate interosseous ligament did not exceed 20 N [95]. The scapholunate interosseous ligament provides a flexion force on the lunate given its attachment to the scaphoid [83]. The lunotriquetral interosseous ligament provides an extension moment on the lunate given its attachment to the triquetrum [83].

Pathophysiology of Instability

Carpal instability exists when the wrist is unable to maintain normal alignment as it moves through its motion arc under physiologic loads [41]. Progressive perilunate instability describes a global pattern of injury propagation centered on the lunate [41]. Dorsal intercalated segment instability (DISI) and volar intercalated segment instability (VISI) are the two most common malalignment patterns in carpal instability [41]. An isolated injury to the scapholunate interosseous ligament may lead to a progression of abnormal joint mechanics, cartilage wear, and degenerative change [70]. Intervention for scapholunate instability aims to halt the degenerative process by restoring ligament integrity and normalizing carpal kinematics [16]. Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows [107]. Hysteresis in wrist kinematics is greater in wrists with scapholunate ligament injury than in healthy wrists [113]. Kinematic changes following scapholunate ligament injury may predict the development of radioscaphoid arthritis [99]. The effect of ligament sectioning on producing carpal instability may be moderated by the bone geometry of the radiocarpal joint [126]. Perilunate dislocations typically result from forces applied to the thenar area with the wrist in dorsiflexion and ulnar deviation, leading to a progressive radial-to-ulnar injury pattern [160]. Mayfield stage III perilunate injury specifically involves disruption of the lunotriquetral support structures following injury to the scapholunate ligament or scaphoid [160].

Classification

General Principles and Pathomechanics

Multiple classification schemes exist to elucidate the mechanistic evolution and pathophysiology of carpal instability [41]. Progressive perilunate instability describes the global pattern of injury propagation centered on the lunate [41]. The two most common malalignment patterns are volar intercalated segment instability and dorsal intercalated segment instability [41]. Recent classifications emphasize relationships within and between carpal rows, categorizing instability as dissociative, nondissociative, adaptive, or complex [41]. Most scapholunate dissociations represent the first stage of carpal instability around the lunate, as described by Mayfield et al. (1980) [72]. The injury mechanism involves wrist hyperextension, ulnar deviation, and midcarpal supination [72]. Force progression leads to capitolunate dissociation (stage II), followed by lunotriquetral ligament disruption (stage III), and finally palmar lunate dislocation [72]. Failure of proper scapholunate ligament healing may be followed by failure of secondary scaphoid stabilizers, specifically the scaphotrapezial trapezoidal ligaments, leading to overall carpal dysfunction [72].

The natural history of scapholunate ligament injuries is poorly understood, and it remains unknown which specific injuries lead to wrist arthritis [13]. An isolated injury to the scapholunate interosseous ligament may herald a relentless progression to abnormal joint mechanics, cartilage wear, and degenerative change [70]. Intervention aims to halt or arrest the degenerative process by restoring ligament integrity or continuity and normalizing carpal kinematics [16, 70]. A pattern of kinematic changes is established after scapholunate ligament injury despite individual variance [44]. Systematic reviews highlight variability in arthritis patterns following these injuries and underscore the lack of consensus regarding management strategies [26].

Arthroscopic Classifications

Arthroscopy is considered the gold standard for complete evaluation of scapholunate interosseous ligament injury and is often performed as a first step before repair or reconstruction [25]. It is extremely sensitive for detecting the spectrum of injury to the scapholunate interosseous ligament [30]. Wrist arthroscopy has provided clear knowledge of the precise dimension and pattern of intercarpal lesions, contributing to improved and more accurate classification systems [179].

Geissler: The Geissler classification is a commonly used arthroscopic system to describe and grade the severity of injury to the scapholunate interval [154]. In a cadaveric model, a Geissler stage 2 lesion correlated with varying degrees of sectioning to the intrinsic ligaments only, with all extrinsic ligaments intact [154]. Arthroscopically determined Geissler grade is associated with specific anatomic lesions of the scapholunate supporting ligaments [156].

EWAS: The EWAS classification is an evolution of present arthroscopic classifications developed to understand the pathogenesis of scapholunate injuries [170]. Stage 3A is obtained when the scapholunate ligament's volar and intermediate portion and/or scaphocapitate/long radiolunate ligaments are sectioned [170]. Stage 3B is obtained by cutting the intermediate and posterior portion of the scapholunate interosseous ligament [170]. Stage 3C is obtained when section of the posterior scapholunate interosseous ligament is performed as well [170]. Stage IV is obtained when the dorsal intercarpal ligament is also sectioned [170].

Dorsal Capsulo-Scapholunate Septum: A study provides an anatomical description of the dorsal capsulo-scapholunate septum and establishes an arthroscopic staging system for scapholunate instability following its sectioning [147].

Radiographic and Clinical Classifications

The scapholunate C-sign is a valuable clinical indicator, demonstrating good diagnostic accuracy in detecting high-grade, through-and-through scapholunate interosseous ligament injuries that may warrant surgical intervention [28]. Both plain radiographs and cineradiography remain key elements of primary diagnostic strategies for suspected traumatic scapholunate dissociation and may facilitate the selection of additional tests [5]. Radiographs are moderately reliable and are better at ruling out than ruling in scapholunate dissociation associated with type C fracture of the distal radius [73]. Injuries to the scapholunate and lunotriquetral interosseous ligaments occur in approximately one third of distal radius fractures, but their diagnosis is challenging as plain radiographs are not reliably diagnostic [29]. Findings from certain studies question the utility of stress radiographs when assessing for scapholunate ligament injuries [32]. Results support the need for a revised classification system that integrates both ligament and cartilage pathology to enable more tailored treatment strategies for scapholunate ligament injuries [42].

Treatment Algorithms Based on Classification

Treatment algorithms are proposed based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes [16]. A novel ligament-based treatment algorithm is proposed based on injury stage and arthritic changes [56]. An algorithm for treatment is proposed based on the stage of injury, degree of secondary ligamentous damage, and arthritic change [70]. An algorithm for treatment is proposed based on the stage of injury and the degree of secondary ligamentous damage and arthritic change [143]. Scapholunate reconstruction procedures are best stratified according to preoperative stages of dissociative instability, injury chronicity, and arthrosis [153].

Geissler-Based Management: Geissler suggested immobilization of grade I injuries, arthroscopic reduction and K-wire pinning for grade II injuries, arthroscopic or open reduction and K-wire pinning for grade III injuries, and open reduction and repair for grade IV injuries [177]. The treatment of grade III scapholunate injuries remains controversial [177].

Clinical Presentation

History and Mechanism

A substantial fall on an outstretched wrist should raise concern about injury to the scapholunate ligament complex, as wrist extension and intercarpal supination are the primary mechanisms of injury [129]. Scapholunate dissociation usually results from excessive wrist extension with the wrist in ulnar deviation [130]. Patients may report a history of previous trauma, although often the patient does not recall a specific antecedent event [27]. Athletes with scapholunate injuries may give a history of the fall mechanism in the acute setting or a past history [130].

Physical Examination

Systematic palpation of the wrist reveals tenderness over the dorsal scapholunate ligament, located just distal to Lister's tubercle [129]. Physical examination findings may include pain dorsally over the scapholunate interval, decreased grip strength, or decreased range of motion [130]. The scaphoid shift test is the principal provocative maneuver to assess scapholunate pathology [129]. A complete injury to the scapholunate ligament complex reveals subluxation of the proximal pole from the scaphoid fossa during the scaphoid shift test [129]. A partial tear may reveal only pain along the dorsal scapholunate ligament during the scaphoid shift test [129]. Crepitation at the radioscaphoid articulation during the scaphoid shift test is indicative of cartilage degeneration and an old injury [129]. The scaphoid shift test should be performed on both the injured and noninjured wrist to assess inherent laxity [129].

The scapholunate C-sign is a valuable clinical indicator demonstrating good diagnostic accuracy in detecting high-grade, through-and-through scapholunate interosseous ligament injuries [28]. A characteristic clinical pattern for predynamic scapholunate ligament attenuation includes chronic dorsal wrist pain especially under loading in wrist extension [49]. This pattern also includes a positive Watson test or apprehension with pain during the examination but without a reduction clunk [49]. The evaluation of the injured wrist on the field and in the office requires fundamental knowledge of the anatomy of the wrist and its kinematics [38].

Imaging

Plain radiographs and cineradiography remain key elements of primary diagnostic strategies for suspected traumatic scapholunate dissociation [5]. Radiographs can detect dorsal scaphoid translation in scapholunate dissociation [46]. Measurements in the middle of the scapholunate joint in neutral and 30° of ulnar deviation under fluoroscopic imaging best capture all stages of ligamentous disruptions [20]. Traction radiography might not be sufficient to reliably diagnose an acute, complete scapholunate interosseous ligament tear [50]. Bilateral widening of the scapholunate joint space is relatively common in the absence of trauma [136].

An early MRI scan at 2 weeks allows the clinician to make the appropriate decision for patients with occult scaphoid fractures, other occult carpal and radial fractures, ligamentous injuries, and those without apparent injuries [14]. MRI is more sensitive and specific to accurately distinguish scapholunate injuries from other carpal ligament and tendon injuries [130]. Wrist arthroscopy is the gold standard for diagnosis and has allowed for a more nuanced understanding of the continuum of scapholunate instability [49]. In patients with suspected scapholunate tears, midcarpal arthroscopy often leads to a change in diagnosis and procedure performed [31]. The arthrogram should not be considered a definitive study for the diagnosis of a clinically important injury of a ligament in the wrist [52].

Associated Pathology

These findings support the need for a higher index of suspicion for scapholunate dissociation in two-part articular fractures of the distal radius [53]. This case provides direct evidence of isolated trauma precipitating both Kienbock's disease and scapholunate dissociation [54]. Lunotriquetral ligament tears are uncommon, variably diagnosed, and often diagnosed in association with other wrist pathology [45]. Simultaneous complete tears of the scapholunate and lunotriquetral ligaments create a "floating lunate" and indicate a severe ligamentous lesion [120]. Occasionally, the patient presents with a secondary problem such as carpal tunnel syndrome, which can occur from a decreased volume of the carpal canal as a result of the degenerative wrist condition [27].

Investigations

Plain radiography: Standard anteroposterior and lateral views provide baseline assessment of carpal alignment. On the lateral view, the axes of the radius, lunate, capitate, and third metacarpal are co-linear, while the scaphoid projects at an angle of approximately 45 degrees to this line [105]. Dorsal intercalated segmental instability (DISI) is characterized by the lunate tilting backwards, with the axes of the capitate and metacarpals lying dorsal to that of the radius [105]. Conversely, volar intercalated segment instability (VISI) presents with the lunate and scaphoid tilting volarwards, and the capitate and metacarpals lying anterior to the radius [105]. Unusual gaps between the scaphoid and lunate on radiographs suggest ligament disruption [105]. An anteroposterior view with the fist clenched may be added if scapholunate injury is suspected [105].

Stress views and specialized radiographic techniques have variable utility. Increased scapholunate widening on Twist views correlates positively with clinical findings and MRI results [175]. However, validation studies question the utility of stress radiographs for assessing scapholunate ligament injuries [32], and traction radiography may not reliably diagnose acute, complete scapholunate interosseous ligament tears [50]. In the context of distal radius fractures treated with volar plating, scapholunate instability is uncommon from initial injury or progression of occult ligament injury, despite early motion without operative treatment [3]. Radiologists demonstrate a low threshold for identifying scapholunate ligament injury in distal radius fractures, whereas treating surgeons identify a remarkably smaller number [161]. Bilateral radiographic scapholunate dissociation is more common than previously assumed, is often asymptomatic, and does not inevitably lead to degenerative arthritis [186].

MRI: MRI is not recommended for the diagnosis of scapholunate ligament injury [47]. However, a properly performed, high-resolution MRI aids in the evaluation of wrist ligament injuries [100]. A static magnetic field strength of at least 1.5 T using a dedicated wrist coil is recommended for analyzing interosseous, intrinsic, and extrinsic ligament insertions [100]. The volar extrinsic, scapholunate interosseous, dorsal intercarpal, and lunotriquetral ligaments are best visualized using 1 mm slices with no interslice gap in the coronal plane [100]. Oblique axial views along the longitudinal axes of these ligaments allow further analysis, especially when injury is suspected [100]. With optimal technique and equipment, the integrity of the scapholunate and lunotriquetral ligaments can be consistently assessed [104]. The addition of arthrographic contrast improves the visualization of these ligaments on MR images [104].

3.0-T MRI of the wrist is moderately sensitive and very specific for detecting complete scapholunate ligament tears, reducing the need for invasive diagnostic techniques in some cases [181]. Concomitant cartilage-sensitive imaging is integrative to influence assessment and surgical management, as cartilage integrity influences clinical and surgical management, especially in the setting of SLAC wrist [100]. Real-time MRI has been used to investigate dynamic instabilities, although its routine use in clinical practice is yet to be further determined [100]. MRI-detectable carpal lesions at the time of radial fracture are common, but only a few seem to decompensate later to become symptomatic and of therapeutic relevance [145]. While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy [157]. Isolated short radiolunate ligament injury is rare and can easily be missed; a tailored MRI protocol can help establish a diagnosis [152].

CT: Four-dimensional computed tomography aids assessment of chronic scapholunate instability, allowing differentiation between patients without and those with definite or questionable scapholunate instability [185]. A study aims to determine the diagnostic accuracy of dynamic 4D CT for diagnosing instable scapholunate ligament tears compared to arthroscopy [193]. A novel dynamic CT scan of the wrist is a user-friendly way of measuring the scapholunate distance, which is minimal in the normal wrist below 40 years of age [188]. CT scanning enables the 3D analysis of carpal dysfunction [100].

Arthroscopy: Arthroscopy is considered by many to be the diagnostic intervention of choice for determining the degree of wrist injury [100]. It can assess the condition of the cartilage, the ability to reduce the carpus, and any other associated injuries [100]. The degree of intrinsic and extrinsic ligament injury can be identified from arthroscopic evaluation [100]. Geissler grade II scapholunate interosseous ligament injuries tend to be isolated, whereas grade IV injuries often involve complete dorsal extrinsic ligament disruption [100]. Early arthroscopic diagnosis of scapholunate injury is mandatory for establishing the prognosis, as proper ligament repair is recommended within four to six weeks after trauma [7].

Other Imaging Modalities: Cineradiography has a high diagnostic value for diagnosing scapholunate dissociations [139]. Dynamic fluoroscopy shows abnormal motion between the scaphoid and lunate and changes in the kinematics of the midcarpal joint [100]. In scapholunate dissociation patients with DISI, the triquetrum-hamate relationship remains permanently engaged, whereas normally it changes from full engagement in ulnar deviation to complete disengagement in radial deviation [100]. Live imaging shows whether the DISI is reducible, giving the physician valuable information as treatment is planned [100]. The report strongly suggests that the arthrogram should not be considered a definitive study for the diagnosis of a clinically important injury of a ligament in the wrist [52].

Treatment

Non-Operative

Scientific and clinical evidence is applied to a treatment paradigm for scapholunate injury, which is modified based on emerging evidence [61]. Optimal management of stage-one scapholunate instability has not been established [134].

Operative

Indications: The ideal treatment for scapholunate instability remains an unresolved problem with inconsistent results and ongoing concerns regarding complications [9]. A systematic review highlights the variability in arthritis patterns following scapholunate ligament injuries and underscores the lack of consensus regarding management strategies [26]. Choosing a treatment technique depends on the stage and characteristics of the scapholunate interosseous ligament injury, scapholunate joint stability, and the physical demands of the patient [150]. An appreciation of patient wishes, risk tolerance, and athletic or occupational needs allows a physician to develop an individualized treatment strategy [150]. An algorithm of treatment based on prognostic factors helps decide which surgical technique is best for each individual case of scapholunate dissociation [18]. Various surgical techniques for scapholunate ligament repair or reconstruction are proposed based on clinical stages and anatomic-pathologic findings, with specific indications for each type of tear ranging from dorsal capsulodesis to tenodesis procedures [57].

Surgical Approach / Technique: Early arthroscopic diagnosis of scapholunate injury is mandatory for establishing the prognosis, as a proper ligament repair is recommended within four to six weeks after trauma [7]. Acute intervention (within 6 weeks) was preferable to chronic intervention for scapholunate interosseous ligament injuries [21]. In carefully selected cases of severe carpal trauma, acute salvage procedures may be a viable alternative to open reduction and internal fixation and ligament repair or reconstruction [36]. Mini-invasive arthroscopic dorsal repair is an efficient technique sufficient for achieving long-term stability [62]. Scapholunate stability is maintained by a whole anatomic complex rather than the scapholunate ligament alone [62]. The RASL (Reduction and Association of the Scaphoid and Lunate) procedure is a safe and effective procedure for the treatment of chronic scapholunate dissociation [133]. With a majority of patients experiencing early radiographic failure of the RASL procedure in the short term, the procedure should be abandoned despite relatively low outcomes measures scores [37]. The ANAFAB (Anatomical anterior and posterior reconstruction) repair achieved excellent realignment of the carpus with a median postoperative scapholunate gap of 3 mm and recovery of more than 75% of grip strength and range of motion [142]. Arthroscopic graft reconstruction for nonrepairable scapholunate ligament injuries is technically demanding but maintains secondary stabilizers and capsular vascularity, allowing for earlier mobilization compared with open procedures [149]. The scapholunate gap in all patients was within the normal range after a mean of 8.1 years of follow-up following dorsal intercarpal ligament capsulodesis with scapholunate interosseous ligament repair for subacute and chronic static scapholunate instability [23]. Although the consequent ongoing scapholunate instability resulted in early arthritic degeneration, most patients had acceptable long-term function of the wrist following dorsal intercarpal ligament capsulodesis for chronic scapholunate instability [17]. At final follow-up, there was a certain loss of scapholunate reduction in patients treated with modified Brunelli tenodesis for static scapholunate instability [19].

Implant Selection: Scapholunate ligament reconstruction using an acellular dermal matrix warrants clinical investigation as a potential treatment alternative for chronic scapholunate instability [148]. The lack of long-term outcome measurements for bone-tissue-bone (BTB) surgeries makes it difficult to determine their appropriate use, but early reports indicate the BTB graft will be an important part of scapholunate dissociation treatment [65].

Adjuncts: Treatment of scapholunate injuries grade I with thermal shrinkage is more effective than arthroscopic debridement [144]. For lesions of grade II and III, thermal shrinkage associated with pinning with K-wire is more effective than only arthroscopic debridement and pinning [144]. Capsular shrinkage has special application in the treatment of Geissler grade 1 and 2 tears, which represent predynamic scapholunate ligament attenuation without disruption [49].

Other Considerations: Scapholunate instability was uncommon in patients with distal radius volar plating, either from initial injury or possible progression of occult ligament injury, despite early motion without operative treatment of the ligament [3]. The authors suggest that concomitant scaphoid fracture and scapholunate ligament injury may represent a relative contraindication to the use of a scapholunate screw [48]. Proximal row carpectomy is not recommended for the management of scapholunate dissociation in the absence of degenerative changes due to disappointing results compared to other treatments [180]. Scaphocapitolunate arthrodesis and radial styloidectomy is a treatment option for posttraumatic degenerative wrist disease, such as SNAC and SLAC wrists [27]. Lunate-capitate fusion is not less efficient than four-corner fusion in the treatment of SNAC II and III wrist injuries [141]. Although some may see motion preserving procedures of the wrist as a staged full wrist fusion, good long-term results can be obtained if indications are accurately respected and the technique is well performed to prevent complications [155]. Treatment of lunotriquetral ligament injuries remains controversial, but ligament repair or reconstruction is preferred over arthrodesis as it preserves motion and offers the greatest likelihood of restoring normal carpal kinematics [71]. Surgical management of stage-one scapholunate instability may include debridement or electrothermal shrinkage [134].

Complications

Degenerative Progression and Arthritis

Delayed diagnosis of scapholunate dissociation permits progressive degenerative change in articular surfaces due to altered contact and load-bearing areas [72]. Complete scapholunate dissociation with carpal malalignment leads to gradual wrist arthritis [146]. Scapholunate ligament damage disrupts wrist stability, altering bone movement and angles, which results in radial deviation and proximal displacement of the scaphoid and lunate [184]. Ongoing instability following dorsal intercarpal ligament capsulodesis has been associated with early arthritic degeneration [17].

Surgical Complications and Technical Failures

A majority of patients experience early radiographic failure of reduction and association of the scaphoid and lunate in the short term [37]. Modified Brunelli tenodesis is associated with a certain loss of scapholunate reduction at final follow-up [19]. Transient vascular compromise of the lunate or proximal scaphoid fragment was noted in three patients undergoing open reduction of chronic lunate and perilunate dislocations [166]. The incidence of carpal bone tunnel collapse is unknown, but consequences may be substantial; patients should be warned of this possibility when discussing complications of ligament reconstruction requiring bone tunnel creation [164]. Arthroscopic capsulodesis appears to offer a low complication rate in higher-grade scapholunate ligament injuries [34].

Long-Term Outcomes and Residual Instability

Despite early arthritic degeneration, most patients achieve acceptable long-term wrist function following dorsal intercarpal ligament capsulodesis [17]. Following dorsal intercarpal ligament capsulodesis with scapholunate interosseous ligament repair, the scapholunate gap remains within the normal range in all patients at a mean follow-up of 8.1 years [23]. Functional results are good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients undergoing 4-corner fusion [51].

Recovery

Prognosis and Natural History: In patients with an extraarticular distal radial fracture, no surgical treatment is usually needed when the scapholunate gap measures between 2.1 and 3.4 mm [68]. This observation is based on a mean follow-up of 6.2 years [68].

Acute and Subacute Outcomes: Acute intervention within 6 weeks is preferable to chronic intervention for scapholunate interosseous ligament injuries [21]. Direct scapholunate ligament repair in acute cases of scapholunate instability produces reasonable clinical outcomes [33]. Direct bony fixation of the ruptured scapholunate ligament using a suture anchor is generally successful in restoring scapholunate stability and has produced acceptable functional mid-term results for this difficult-to-treat injury [22]. At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results [67]. Patients with less than 3 months' history of instability symptoms and with less than 3 mm of side-to-side difference in the scapholunate interval maintained reduction of the interval and symptom relief with an 83% incidence [64].

Chronic and Long-Term Outcomes: At final follow-up, there was a certain loss of scapholunate reduction following modified Brunelli tenodesis for static scapholunate instability [19]. Scapholunate ligament reconstruction using a part of the extensor carpi radialis brevis tendon through a dorsal approach resulted in long-term, improved outcomes compared with other techniques, even in scapholunate advanced collapse type I wrists [24]. With a mean follow-up greater than 5 years, there was no substantial difference in clinical outcomes and patient-based outcome questionnaires between capsulodesis, tenodesis, or bone-ligament-bone reconstruction for the treatment of scapholunate instability [169]. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients undergoing 4-corner fusion for SLAC and SNAC wrist [51]. Despite radiographic progression, radiolunate and radioscapholunate arthrodeses yield good clinical results at long-term follow-up [195].

Complications and Limitations: With a majority of patients experiencing early radiographic failure of the procedure in the short term, the reduction and association of the scaphoid and lunate procedure should be abandoned despite the relatively low outcomes measures scores [37]. Delayed diagnosis and late reconstructive surgery were associated with no improvement in radiolunate angle in traumatic nondissociative carpal instability [74]. The lack of long-term outcome measurements for bone-tissue-bone (BTB) surgeries makes it difficult for the hand surgeon to determine the appropriate use of these treatment modalities, but early reports have indicated that the BTB graft will be an important part of scapholunate dissociation treatment [65]. The cable augmented, quad ligament scapholunate ligament reconstruction offers theoretical advantages but long term follow up is required [165]. Long-term clinical prospective trials are needed to examine whether scapholunate dysfunction and osteoarthritic changes are prevented by modified arthroscopic volar scapholunate capsuloligamentous repair in chronic severe but reducible volar scapholunate instability [69].

Key Evidence

• [L4] Scapholunate instability was uncommon in this population, either from initial injury or possible progression of occult ligament injury, despite early motion without operative treatment of the ligament. [3] (10.1007/s11552-015-9779-2)
• [L3] This incidence is higher than previously reported and emphasizes the need for careful assessment of the intrinsic and extrinsic ligaments, particularly the scapholunate ligament, before deciding on treatment. [4] (10.1016/j.jhsa.2009.12.023)
• [L4] Both methods remain key elements of primary diagnostic strategies for suspected traumatic scapholunate dissociation, and may facilitate the selection of additional tests. [5] (10.1007/s00256-007-0410-7)
• [L5] Early arthroscopic diagnosis of scapholunate injury is mandatory for establishing the prognosis of the injury, as a proper ligament repair is recommended within four to six weeks after trauma. [7] (10.1302/2058-5241.2.170016)
• [L5] No strong evidence currently supports any one treatment for scapholunate ligament injuries. [8] (10.5435/jaaos-d-14-00254)
• [L5] Despite the evolution of diagnostic and treatment options, the ideal treatment for scapholunate instability remains an unresolved problem with inconsistent results and ongoing concerns regarding complications. [9] (10.1177/17531934221148009)
• [L5] Current opinion supports repairing or reconstructing the scapholunate interosseous ligament in active individuals with instability symptoms and minimal or no carpal arthritis, though no clear consensus exists for all scenarios. [10] (10.1016/j.jhsa.2009.03.019)
• [L3] The outcomes of intraarticular fractures of the distal radius with operatively treated associated scapholunate ligament injury are comparable with the outcomes of intraarticular fractures of the distal radius without associated scapholunate ligament injury. [12] (10.1007/s00402-013-1797-3)
• [L5] The natural history of scapholunate ligament injuries is poorly understood, and it is unknown which injuries lead to wrist arthritis. [13] (10.1007/s11552-013-9499-4)
• [L2] An early MRI scan at 2 weeks allows the clinician to make the appropriate decision for patients with occult scaphoid fractures, other occult carpal and radial fractures, ligamentous injuries, and those without apparent injuries. [14] (10.1016/s0020-1383(98)00115-6)
• [L5] [16] (10.1016/j.jhsa.2023.06.016)
• [L3] Although the consequent ongoing scapholunate instability resulted in early arthritic degeneration, most patients had acceptable long-term function of the wrist. [17] (10.1302/0301-620x.94b12.30007)
• [L4] The article presents an algorithm of treatment based on prognostic factors to help decide which surgical technique is best for each individual case of scapholunate dissociation. [18] (10.1016/j.jhsa.2005.10.011)
• [L4] At final follow-up there was a certain loss of scapholunate reduction. [19] (10.1016/j.jhsa.2013.02.022)
• [L5] Measurements in the middle of the scapholunate joint in neutral and 30° of ulnar deviation under fluoroscopic imaging best capture all stages of ligamentous disruptions. [20] (10.1177/1558944717729219)
• [L3] Acute intervention (within 6 wk) was preferable to chronic intervention for scapholunate interosseous ligament injuries. [21] (10.1016/j.jhsa.2014.06.139)
• [L4] Direct bony fixation of the ruptured scapholunate ligament using a suture anchor is generally successful in restoring scapholunate stability and has produced acceptable functional mid-term results for this difficult-to-treat injury. [22] (10.1054/jhsb.1999.0340)
• [L4] The scapholunate gap in all patients was within the normal range after a mean of 8.1 years of follow-up. [23] (10.1016/j.jhsg.2022.01.007)
• [L4] This technique, even in scapholunate advanced collapse type I wrists, resulted in long-term, improved outcomes compared with other techniques. [24] (10.1177/17531934221143679)
• [L5] Arthroscopy is considered the gold standard for complete evaluation of scapholunate interosseous ligament injury and often is performed as a first step before repair or reconstruction. [25] (10.5435/00124635-200201000-00006)
• [L1] The systematic review highlights the variability in arthritis patterns following scapholunate ligament injuries and underscores the lack of consensus regarding management strategies. [26] (10.1016/j.jhsg.2025.100827)
• [L4] [27] (10.1055/s-0032-1329592)
• [L2] The scapholunate C-sign is a valuable clinical indicator, demonstrating good diagnostic accuracy in detecting high-grade, through-and-through scapholunate interosseous ligament injuries that may warrant surgical intervention. [28] (10.1016/j.jhsa.2025.06.011)
• [L4] Injuries to the scapholunate and lunotriquetral interosseous ligaments occur in approximately one third of distal radius fractures, but their diagnosis is challenging as plain radiographs are not reliably diagnostic. [29] (10.5435/jaaos-d-18-00503)
• [L4] It is extremely sensitive for detecting the spectrum of injury to the scapholunate interosseous ligament. [30] (10.1055/s-0033-1343354)
• [L3] In patients with suspected scapholunate tears, midcarpal arthroscopy often leads to a change in diagnosis and procedure performed. [31] (10.1016/j.jhsa.2013.08.040)
• [L4] These findings question the utility of stress radiographs when assessing for scapholunate ligament injuries. [32] (10.1177/15589447231223774)
• [L5] Literature review reveals that direct scapholunate ligament repair in acute cases of scapholunate instability can produce reasonable clinical outcomes. [33] (10.1016/j.hcl.2015.04.008)
• [L4] Arthroscopic capsulodesis appears to offer significant functional improvement and a low complication rate in higher grade scapholunate ligament injuries. [34] (10.1177/17531934261472361)
• [L3] Both versions of the scapholunate intercarpal ligamentoplasty yield satisfactory clinical and radiological results in the short to mid-term. [35] (10.1177/1753193420940498)
• [Case_report] In carefully selected cases of severe carpal trauma, acute salvage procedures may be a viable alternative to ORIF and ligament repair/reconstruction. [36] (10.1007/s11552-012-9462-9)
• [L4] With a majority of patients experiencing early radiographic failure of the procedure in the short term, our experience suggests that the reduction and association of the scaphoid and lunate procedure should be abandoned despite the relatively low outcomes measures scores. [37] (10.1016/j.jhsa.2014.07.014)
• [L5] The evaluation of the injured wrist on the field and in the office requires fundamental knowledge of the anatomy of the wrist and its kinematics. [38] (10.1016/s0278-5919(05)70094-6)
• [L5] [41] (10.1016/j.hcl.2015.04.011)
• [L3] These results support the need for a revised classification system that integrates both ligament and cartilage pathology to enable more tailored treatment strategies for scapholunate ligament injuries. [42] (10.1177/17531934251407799)
• [L5] Despite individual variance, a pattern of kinematic changes was established after scapholunate ligament injury. [44] (10.1177/1753193415600669)
• [L4] Lunotriquetral ligament tears are uncommon, variably diagnosed, and often diagnosed in association with other wrist pathology. [45] (10.1016/j.jhsa.2012.04.007)
• [L3] [46] (10.1055/s-0038-1677536)
• [L3] MRI is not recommended for the diagnosis of scapholunate ligament injury. [47] (10.1054/jhsb.2000.0450)
• [Case_report] The authors suggest that concomitant scaphoid fracture and SL ligament injury may represent a relative contraindication to this procedure. [48] (10.1007/s11552-012-9463-8)
• [L4] [49] (10.1016/j.hcl.2011.06.005)
• [L5] The findings suggest that traction radiography might not be sufficient to reliably diagnose an acute, complete scapholunate interosseous ligament tear. [50] (10.1177/1753193411434038)
• [L4] Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. [51] (10.1177/1558944716681949)
• [L4] The report strongly suggests that the arthrogram should not be considered a definitive study for the diagnosis of a clinically important injury of a ligament in the wrist. [52] (10.2106/00004623-199508000-00010)
• [L3] These findings support the need for a higher index of suspicion for scapholunate dissociation in these distal radial fracture subtypes. [53] (10.1177/1753193419826490)
• [L4] This case provides direct evidence of isolated trauma precipitating both Kienbock's disease and scapholunate dissociation. [54] (10.1007/s11552-012-9477-2)
• [L5] This review provides an update on the anatomy of the scapholunate ligament complex, the importance of critical ligament stabilizers, and pathoanatomy to inform treatment of scapholunate dissociation, proposing a novel ligament-based treatment algorithm based on injury stage and arthritic changes. [56] (10.1016/j.jhsa.2023.05.013)
• [L4] The paper reviews various surgical techniques for scapholunate ligament repair or reconstruction based on clinical stages and anatomic-pathologic findings, proposing specific indications for each type of tear from dorsal capsulodesis to tenodesis procedures. [57] (10.1055/s-0033-1343092)
• [L5] The article demonstrates how scientific and clinical evidence is applied to a treatment paradigm for scapholunate injury and modified based on emerging evidence. [61] (10.1016/j.jht.2016.03.010)
• [L5] Scapholunate stability is maintained by a whole anatomic complex rather than the scapholunate ligament alone, and mini-invasive arthroscopic dorsal repair is an efficient technique sufficient for achieving long-term stability. [62] (10.1177/1753193420956319)
• [L4] Although fewer in number, repair techniques for isolated volar scapholunate interosseous ligament injuries appear promising with the limited data available. [63] (10.1016/j.jhsg.2023.03.015)
• [L4] Those patients with less than 3 months' history of instability symptoms and with less than 3 mm of side-to-side difference in the scapholunate interval maintained reduction of the interval and symptom relief with an 83% incidence. [64] (10.1016/s0749-0712(21)00024-x)
• [L4] The lack of long-term outcome measurements for these BTB surgeries makes it difficult for the hand surgeon to determine the appropriate use of these treatment modalities, but early reports have indicated that the BTB graft will be an important part of scapholunate dissociation treatment. [65] (10.1016/j.jhsa.2006.11.011)
• [L5] Strong evidence (level 1 or 2) for management of scapholunate instability in the absence of arthritis is lacking and published recommendations are largely experience-based. [66] (10.1177/1753193412473861)
• [L4] At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results. [67] (10.1186/s13018-023-04148-y)
• [L3] At a mean follow up of 6.2 years following an extraarticular distal radial fracture, no surgical treatment is usually needed with a scapholunate gap of between 2.1 -3.4 mm. [68] (10.1055/s-0034-1372514)
• [Paper] Long-term clinical prospective trials are needed to examine whether scapholunate dysfunction and osteoarthritic changes are prevented by this capsuloligamentous plicature. [69] (10.1016/j.eats.2024.103424)
• [L5] [70] (10.1016/j.jhsa.2008.04.027)
• [L4] Treatment of LT ligament injuries remains controversial, but the authors prefer ligament repair or reconstruction over arthrodesis as it preserves motion and offers the greatest likelihood of restoring normal carpal kinematics. [71] (10.5435/00124635-200005000-00004)
• [L4] [72] (10.1177/1753193415587871)
• [L3] Radiographs are moderately reliable and are better at ruling out than ruling in scapholunate dissociation associated with type C fracture of the distal radius. [73] (10.1016/j.jhsa.2013.05.039)
• [L4] Delayed diagnosis and late reconstructive surgery were associated with no improvement in radiolunate angle. [74] (10.1016/j.jhsa.2021.04.024)
• [L5] However, the wrist behaves kinematically consistent but kinetically variable, implying that mechanical behavior is predominantly determined by articular geometry rather than ligament constraints. [76] (10.1002/jor.1100100620)
• [L5] Clinically, a DTM at approximately 30° to 45° from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion. [94] (10.1016/j.jhsa.2007.08.014)
• [L5] However, during simple unresisted wrist motions, the force did not exceed 20 N. [95] (10.1016/j.jhsa.2015.04.007)
• [L3] These kinematic changes may predict the development of radioscaphoid arthritis and help identify a kinematically abnormal wrist. [99] (10.1177/17531934241242676)
• [L4] Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. [107] (10.1016/j.jhsa.2008.03.008)
• [L5] Most carpal ligaments lengthen only during one half of a full movement cycle, constraining either dorsal- or palmar-directed, or ulnar- or radial-directed motion. [108] (10.1002/jor.1100090509)
• [L3] This study demonstrated that hysteresis can be quantified using 4DCT wrist kinematics and is greater in wrists with scapholunate ligament injury than in healthy wrists. [113] (10.1177/17531934261468199)
• [L4] [120] (10.1007/s11552-008-9155-6)
• [L5] The effect of ligament sectioning on producing carpal instability may be moderated by the bone geometry of the radiocarpal joint. [126] (10.1016/j.jhsa.2006.10.018)
• [L4] [129] (10.1016/s0749-0712(21)00178-5)
• [L5] [130] (10.1016/j.hcl.2009.05.002)
• [L4] The RASL procedure is a safe and effective procedure for the treatment of chronic scapholunate dissociation. [133] (10.1016/s0363-5023(10)60091-3)
• [L4] [134] (10.1177/17589983241268056)
• [L4] Bilateral widening of the scapholunate joint space is relatively common in the absence of trauma. [136] (10.1177/1753193418819653)
• [L3] Cineradiography has a high diagnostic value for diagnosing scapholunate dissociations. [139] (10.1177/1753193413489056)
• [L4] The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. [141] (10.1186/s12891-024-07755-w)
• [L4] The ANAFAB repair achieved excellent realignment of the carpus with a median postoperative scapholunate gap of 3 mm and recovery of more than 75% of grip strength and range of motion. [142] (10.1177/1753193419886536)
• [L5] This review discusses the anatomy, kinematics, and biomechanical properties of the scapholunate articulation to provide a foundation for understanding the spectrum of scapholunate ligament instability and proposes an algorithm for treatment based on the stage of injury and the degree of secondary ligamentous damage and arthritic change. [143] (10.1016/j.jhsa.2012.07.035)
• [L2] Treatment of scapholunate injuries grade I with shrinkage is more effective than arthroscopic debridement, and associated with pinning with K-wire is more effective than only arthroscopic debridement and pinning for lesions of grade II and III. [144] (10.1016/j.arthro.2007.03.077)
• [L3] MRI-detectable carpal lesions at the time of the radial fracture are common, but only a few of them seem to decompensate later, give symptoms and became of therapeutic relevance. [145] (10.1007/s00402-015-2357-9)
• [L5] [146] (10.1016/j.jhsa.2010.07.015)
• [Paper] The study provides an anatomical description of the DCSS and establishes an arthroscopic staging system for scapholunate instability following DCSS sectioning. [147] (10.1055/s-0033-1338256)
• [L5] Scapholunate ligament reconstruction using acellular dermal matrix warrants clinical investigation as a potential treatment alternative for chronic scapholunate instability. [148] (10.1016/j.jhsa.2012.04.043)
• [L5] [149] (10.1016/j.eats.2025.103820)
• [L5] [150] (10.1016/j.jhsg.2024.01.015)
• [Case_report] Isolated short radiolunate ligament injury is rare and can easily be missed; a tailored MRI protocol can help establish a diagnosis. [152] (10.1016/j.jhsa.2020.11.002)
• [L4] Scapholunate reconstruction procedures are best stratified according to preoperative stages of dissociative instability, injury chronicity, and arthrosis. [153] (10.2106/jbjs.rvw.o.00060)
• [Paper] [154] (10.1016/s0363-5023(09)60081-2)
• [Paper] Although some may see the motion preserving procedures of the wrist as a staged full wrist fusion, if the indications are accurately respected and the technique is well performed to prevent complications, then good long-term results can be obtained. [155] (10.1055/s-0032-1330070)
• [L5] In this cadaveric model, arthroscopically determined Geissler grade was associated with specific anatomic lesions of the scapholunate supporting ligaments. [156] (10.1016/j.jhsa.2015.02.017)
• [L2] While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy. [157] (10.1016/j.jhsa.2024.04.015)
• [L5] [160] (10.1016/j.hcl.2015.04.005)
• [L2] Radiologists demonstrate a low threshold to identify scapholunate ligament injury (SLI) in the setting of distal radius fractures, while the number of SLIs identified by the treating surgeon is a remarkably smaller number. [161] (10.1055/s-0038-1654699)
• [L4] Surgical repair with augmentation ligamentoplasty is indicated for disabling scapholunate interosseous ligament disruption before the occurrence of static, fixed scapholunate dissociation. [163] (10.1016/j.hcl.2012.05.002)
• [L4] Although the incidence of carpal bone tunnel collapse is unknown, the consequences could be substantial; therefore, patients should be warned of this possibility when discussing complications of ligament reconstruction for chronic scapholunate instability requiring the creation of a bone tunnel. [164] (10.1016/j.jhsa.2023.07.008)
• [L4] The cable augmented, quad ligament scapholunate ligament reconstruction offers theoretical advantages but long term follow up is required. [165] (10.1055/s-0035-1564984)
• [L4] [166] (10.1007/bf00573451)
• [L5] These results appear to agree with other reports about the stabilizing role of the palmar portion of the scapholunate ligament and suggest that the palmar portion of the ligament should be considered for surgical repair. [168] (10.1016/j.clinbiomech.2011.04.009)
• [L3] With a mean follow-up greater than 5 years, there was no substantial difference in clinical outcomes and patient-based outcome questionnaires between capsulodesis, tenodesis or bone-ligament-bone reconstruction for the treatment of scapholunate instability. [169] (10.1177/17531934231219191)
• [L5] [170] (10.1055/s-0033-1345265)
• [L4] For stage II SLAC wrist with a preserved capitolunate joint, proximal row carpectomy is preferred because it is technically less demanding and yields durable results. [171] (10.5435/00124635-200307000-00007)
• [L4] The increased scapholunate widening seen on the Twist views has correlated positively, both clinically and with MRI results. [175] (10.1055/s-0038-1673344)
• [L5] [177] (10.1007/s00402-020-03373-y)
• [L5] [179] (10.1055/s-0033-1353532)
• [L4] The authors do not recommend PRC for the management of scapholunate dissociation in the absence of degenerative changes due to disappointing results compared to other treatments. [180] (10.1177/1753193410382719)
• [L2] 3.0-T MRI of the wrist is moderately sensitive and very specific for detection of complete SLL tears, reducing the need for invasive diagnostic techniques in some cases. [181] (10.1055/s-0032-1333425)
• [L5] Scapholunate ligament damage alters wrist stability, affecting bone movement and angles, leading to radial deviation and proximal displacement of the scaphoid and lunate bones. [184] (10.1016/j.jhsg.2024.11.011)
• [L2] Four-dimensional computed tomography aids assessment of chronic scapholunate instability, which allows the differentiation between patients without and those with definite or questionable scapholunate instability. [185] (10.1177/1753193419893890)
• [L3] Bilateral radiographic scapholunate dissociation is much more common than previously assumed, is often asymptomatic, and does not inevitably lead to degenerative arthritis. [186] (10.1016/j.jhsa.2012.03.020)
• [L4] This novel dynamic CT scan of the wrist is a user-friendly way of measuring the scapholunate distance, which is minimal in the normal wrist below 40 years of age. [188] (10.1177/1558944717726372)
• [L4] The study aims to determine the diagnostic accuracy of dynamic 4D CT for diagnosing instable scapholunate ligament tears compared to arthroscopy. [193] (10.1186/s12891-021-03946-x)
• [L4] Despite radiographic progression, radiolunate and radioscapholunate arthrodeses yield good clinical results at long-term follow-up. [195] (10.1016/j.jhsa.2011.10.012)

See Also

• Scaphoid Fracture
• Proximal Row Carpectomy
• Wrist Arthroscopy
• Carpal Tunnel and Nerve Compression
• Wrist Ligament Injuries
• SLAC and SNAC Wrist

References

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